CT Findings of Pulmonary Metastases from Primary Cardiac Angiosarcoma

The diagnosis and treatment for primary cardiac angiosarcoma with N-ras gene mutation and MSI-L: A case report and review of the literature

RATIONALE

Primary cardiac angiosarcomas (PCA) is a rare malignancy with a poor prognosis. Currently, there is no standard treatment protocol for the PCA. We report a case of PCA in a 51-year-old woman.

PATIENT CONCERNS

A 51-year-old woman initially presented with unexplained palpitations and chest tightness accompanied by nausea and vomiting, which worsened after activity and improved after rest. After symptomatic treatment, the symptoms improved, and the above symptoms recurred 8 months later.

DIAGNOSES

Positron emission tomography-computed tomography revealed multiple lung nodules of varying sizes, some of which exhibited increased glucose metabolism. Furthermore, a soft tissue mass protruding into the pericardial cavity and involving the adjacent right atrium was observed in the right pericardium. The mass exhibited increased glucose metabolism, suggestive of a pericardial tumor with multiple lung metastases. Finally, histopathologic diagnosis of metastatic angiosarcoma was done by computed tomography-guided percutaneous lung and mediastinal biopsy.

INTERVENTIONS

The patient was treated with palliative chemotherapy for the primary cardiac angiosarcomas and hematogenous lung metastasis. One cycle later, the result of Next-Generation Sequencing showed that the microsatellite instability status was determined to be low-level. Based on this result, tislelizumab was added to the original chemotherapy regimen.

OUTCOMES

Unfortunately, the patient with PCA passed away after only 2 cycles of chemotherapy, and the cause of death remained unknown.

LESSONS

This case report well demonstrates typical imaging findings of a rare cardiac angiosarcomas and emphasizes importance of early investigation for accurate diagnosis and proper management of the cardiac angiosarcomas.

Patients risk factors and pulmonary nodule characteristics in the differentiation of malignant pulmonary nodules

Background: We have been encountering pulmonary nodules more frequently due to increased lung cancer screening programs and lung tomography imaging for other reasons. Although various guidelines have been developed regarding pulmonary nodules, uncertainty continues on the follow-up and management of nodules. Aim of the study: To define the patients risk factors and pulmonary nodule characteristics that differentiate malignant nodules from benign nodules.Material and Methods: Patients with pulmonary nodules, detected between August 2014 and January 2019 in a university hospital were analyzed retrospectively. The data about the patient-risk factors (age, gender, smoking history, occupational-environmental risks, comorbidities, cancer history, family history) and nodule characteristics (Nodule Diameter, Nodule Type, Border Properties, Nodule Localization) were obtained. The features of malign nodules and benign nodules were examined.Results: There were 40 patients with pulmonary nodules whose final diagnosis could be classified as benign or malign. The mean age was 63.28 (12.06) years. Twenty-two (55%) patients were female. Eleven (27.50%) patients had never smoked. Nineteen (47.50%) of the patients were asymptomatic. Two of the nodules were malignant. There was no significant difference in the mean age, gender, smoking history, comorbidities, occupational and environmental risk factors, familial risk factors, nodule type, localization, size, and border properties between the benign and malign nodules.Conclusion: There is a high overlap in nodule characteristics and patient-risk factors between benign and malign nodules. Despite a comprehensive clinical and radiological evaluation, it is not easy to decide whether the nodule is benign or malign.

Intracardiac biopsy of cardiac tumors with echocardiographic guidance: Case report

Background

Primary cardiac tumors are very rare, and about 20-30% of them are malignant tumors. Since early signs of cardiac tumors are non-specific, diagnosis can be challenging. There is a lack of the recommended guidelines or standardized strategies for diagnosis and optimal treatment for this disease. As the definite diagnoses of most tumors are made by pathologic confirmation, biopsied tissue is essential in determining the treatment for patients with cardiac tumors. Recently, intracardiac echocardiography (ICE) has been introduced to assist biopsy procedures of cardiac tumors and it provides high-quality imaging.

Case Description

Due to its low prevalence and variable presentation, cardiac malignant tumors usually are easily missed. Hereby, we report three cases of patients who presented with non-specific signs of cardiac disorder and was initially suspended diagnosis as lung infection or cancer. Under the guidance of ICE, cardiac biopsies were successfully on cardiac masses, giving critical data for diagnosis and treatment planning. No procedural complications were obtained in our cases. These cases are intended to highlight the clinical value and importance of ICE-guided biopsy of intracardiac mass.

Conclusions

The diagnosis of primary cardiac tumors relies on the histopathological results. In our experience, using ICE for biopsy of an intracardiac mass is an attractive tool to increase diagnostic results and reduce the risk of cardiac complications associated with inadequate targeting of the biopsy catheters.